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Review
. 2016 Aug 1;80(3):179-89.
doi: 10.1016/j.biopsych.2015.10.024. Epub 2015 Nov 17.

Addictions Neuroclinical Assessment: A Neuroscience-Based Framework for Addictive Disorders

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Free PMC article
Review

Addictions Neuroclinical Assessment: A Neuroscience-Based Framework for Addictive Disorders

Laura E Kwako et al. Biol Psychiatry. .
Free PMC article

Abstract

This article proposes a heuristic framework for the Addictions Neuroclinical Assessment that incorporates key functional domains derived from the neurocircuitry of addiction. We review how addictive disorders (ADs) are presently diagnosed and the need for new neuroclinical measures to differentiate patients who meet clinical criteria for addiction to the same agent while differing in etiology, prognosis, and treatment response. The need for a better understanding of the mechanisms provoking and maintaining addiction, as evidenced by the limitations of current treatments and within-diagnosis clinical heterogeneity, is articulated. In addition, recent changes in the nosology of ADs, challenges to current classification systems, and prior attempts to subtype individuals with ADs are described. Complementary initiatives, including the Research Domain Criteria project, that have established frameworks for the neuroscience of psychiatric disorders are discussed. Three domains-executive function, incentive salience, and negative emotionality-tied to different phases in the cycle of addiction form the core functional elements of ADs. Measurement of these domains in epidemiologic, genetic, clinical, and treatment studies will provide the underpinnings for an understanding of cross-population and temporal variation in addictions, shared mechanisms in addictive disorders, impact of changing environmental influences, and gene identification. Finally, we show that it is practical to implement such a deep neuroclinical assessment using a combination of neuroimaging and performance measures. Neuroclinical assessment is key to reconceptualizing the nosology of ADs on the basis of process and etiology, an advance that can lead to improved prevention and treatment.

Keywords: Addiction; Assessment; Diagnosis; Neuroimaging; Nosology; Substance use.

Figures

Figure 1
Figure 1
ANA Primary Domains and Variables for Ancillary Assessment
Figure 2
Figure 2
Proposed ANA Process from Data Capture to Precision Medicine Implementation

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